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Escalating Maladaptive Behaviours

jannyinTO

Good Day everyone.

I am a respite support worker currently helping a 22 year old male on the ASD spectrum. He is largely non-verbal. I work with him as support when he attends his regular day program, 5 days a week.

He has an acute interest in colouring and folding sales flyers with crayons for hours at a time, and has little interest in anything else. He requires constant supervision due to his relationship with this particular interest. I'm posting to get some advice, as his maladaptive behaviours seem to be linked to his "papers", and they are escalating as of late, to the point of being unmanageable.

My greatest issue with him is his "ripping" up and disposing of papers, which we only have a finite supply of.

To preface, I am aware that he at times will rip up his papers as a way to show anger, however lately, he seems to be in "destructive mode" as a way to attempt to control my getting him new papers to colour (as he often has a smirk or smile on his face during these instances). Typically, our relationship is mutual - if he wants new papers to colour, I will trade with him old papers for new. Every now and then if I don't have something he fancies, I will get him other papers to provide him some extra options.

Then I refuse to trade papers with him, or I notice he's doing it to get me out of the room and "waiting" on him multiple times in a short period, I ask him to wait a few minutes, and the next thing I know, he's up and ripping his papers, throwing them in the trash. Staff at his day program and myself keep telling him that if he rips up his papers, he does not get new ones for one hour. We attempt to be as constient with his rule as we can.

This, however, does not seem to be stopping the behaviour, and when he has to wait more than 15 minutes, he becomes very agitated and starts to attempt to escape the room to look around the building for more papers. At times he must be physically followed and pushed out of unwanted spaces. At times, paper-based catalogues, etc have been destroyed in the scuffle. These behaviours increase until he becomes so unmanagable that someone has to get him new papers, or I make an executive decision not to let him have any for the rest of the day - a which for the rest of the day, he is a constant flight risk.

The curious part is that this behaviour only seems to be happening when I am around for the day at his program. On off days when others are caring for him, he sits with only two papers for the entire day, and/or his behaviours deminish.

Obviously, this behaviour is linked to something I am doing incorrectly, or is in some way linked to my presence. I am at a loss as to what may remedy the situation. This is my first ASD client.

If any of you have any ideas, advice, or suggestions, I'd be all ears to hear them.

Thanks. J

  • ^^ great idea missdmeena.

    Janny it sounds to me like your client is looking for something he is secure with in a situation which has, due to recent changes, made him feel very insecure. Because you are new, you are part of this change and he is trying to measure how much you can be trusted. 

    Long man has given you excellent advice, but just to add if the problem is space have you considered post it notes as an alternative? I would advise you to be VERY WARY of others proudly claiming to have made your client cope with just two papers for the whole day - they may see this as an achievement but in reality this may be because they have not truly understood his needs. In supporting your client it is not their job to break him of any 'habit' they perceived as unhelpful or unproductive, I certainly wouldn't be taking their lead on this. If he feels he needs these papers I would allow this as much as it is in your power to do so.

  • I just wondered if you'd come across this and if it would be of any help.

    www.bbc.co.uk/.../magazine-33230754

  • There's a book I used to have with a photo on the front cover of autistic children in a playroom with a rocker and other large interplay toys, simply stupified, static, heads down, bored.  The picture haunts me as an image of institutional life - same things to do, same terms of reference - day in day out.

    I can appreciate the service provider's perspective - limited space and staff (especially in recession), the patients have to fit in to the staff routine. Tough.

    He previously managed with two papers a day. He has expanded to large numbers. What other dimensions are there for him to explore? Is there anything else he could do which he would enjoy? Which might expand his horizons?

    I'm not yet clear whether he is stimming or engaging his mind in an activity. Some people do things like folding and tearing paper as a stim to help focus on other things. Trouble is, if this is him stimming, there seems to be little else for him to do to stimulate his mind - so he is stimming with no other focus. On a rocker, day in day out - like a caged lion.

    Yeah I understand there have to be rules. Wow

  • In response to your excellent post, Longman, let me clarify so that you can continue to respond.

    Primarily, I personally have no issue with the client having access to his papers. If I had my way about the programming or setup of the day program, then I would have an open box of papers available at his leisure and a table for him to colour on undisturbed.

    This, however, is not the reality of day program life for him. The facility where he currently is is group based, and does not have the space to allocate for him to take part in his hobby en masse (as he has a tendency to collect his papers in large numbers), as it interfers with programing activities and space.

    The issue of finite papers is because the parent provides the flyers, etc, and often this is not consistent, or not enough to last him unemcumbered for the day. Also, from grade school to his current age, previous workers have limited him to 2 papers only for the ENTIRE DAY (7 hours long), saying that he is happy with this. Personally I hardly agree, but they do say his negative behaviours decrease on such occasions.

    I absolutely agree that the "meddling" is unnerving him. There have been several requests for changes in his access to papers (i.e. "Give him less papers so that you don't have to be out of the room so much getting him new ones", etc.) Bottom line is that the papers are kept out of sight to avoid him "binge'ing" on his supply, yet it also means that I have to somehow get new papers throughout the day AND negotiate his access and choice at the same time. It's gotten all very complicated.

    I have brought up the idea as a compromise of a lock box in the room, where his use of papers can be stemmed during snack and lunch times (as often he will spit out food or regurgitate in order to ruin his food so that he can get back to his obsession quicker). This request has gone unheeded.

    One other thing of note is the that there has been some rather large changes and transitions in programming in the last couple of weeks, just before the escalating behaviour started. I have some clue that the sudden environmental change may also be to blame in the mix as well, as previous to the programming change (which basically was that all programming was cancelled to practice for a Christmas show the clients were arranging except him), things began to go awry. For over a week, the entire setting had no structure.

    I have no intention of dismantling his world. I simply have a structure around me that does not allow me to cater to him in healthiest way possible. I need to find a compromise somehow, but I am loss as to what that may be, as the care staff are not regularly briefed on such matters and are very critical of any new changes I attempt with the client.

  • I've cited under another posting a fairly old text book (2000) by John Clements & Ewa Zarkowska "Behavioural Concerns and autistic spectrum disorders: explanations and strategies for change" (Jessica Kingsley Publishers). The book explores strategies from lots of clinical contexts. I've picked it up again after finding it hard going before but am persevering this time because i'm finding useful tips for coping strategies.

    My basic grumble about the book is that they go through lots and lots of strategies, but I'm not sure I see outcomes. It is meticulous observation of interactions between support worker and patient without constructive resolve.

    However they seem to have a potential answer for your dilemma - p164 on obsessions, these are some that seemed most apt:

    "Check out your own feelings in relation to special interests to make sure that the reason for setting limits is that the behaviour is causing real problems rather than you thinking that it is a silly way to be spending time"

    "Hobby boxes are very helpful for interests that involve doing something specific (flicking, spinning, juggling, dismantling, tearing). They have to be kept supplied and always accessible at the agreed times".

    The most difficult problems in limiting hobbies is the problem that those setting the limits have in being consistent. Such inconsistency is confusing and handicapping for the person in need of support and can lead to angry confrontations. However once the person finds out you can be trusted and that she does get predictable access to her special interest the intensity subsides and the limits can be tolerated well".

    These writers always seem to write as if the subject is female, in case you are wondering.

    My query would be, why is the supply of papers finite? If this gives him calm and focus and security, why do you need to change this?

    My perception, and I think what Clements & Zarkowska are getting at, is that your meddling is unnerving him. You are, as they say inconsistent in your methods and hardly gaining his trust.

    Why dismantle his world? Do you believe he has to start doing more productive things? Is your job specification to brainwash him? Or to ensure his peace of mind?